Med Surge 1 practice questions

a. anterior

b. posterior

c. Septal

d. Inferior

d. inferior

2. A client has chest pain rated at an 8 on a scale from 1-10. The 12-lead EKG reveals ST elevation in the inferior leads and elevated troponin levels. Which intervention below will help reduce myocardial oxygen demand and deter the infarction from further growing?

a. Administer 324mg of aspirin

b. Keep the patient from exerting himself

c. Administration of epinephrine, intravenously

d. Place the patient on oxygen 2L/m by nasal cannula

d. Place the patient on oxygen 2L/m by nasal cannula

3. A client has a throbbing headache when nitroglycerin is ... angina. The nurse should instruct the client that:

a. The client should be in a supine position to alleviate the headache

b. The pain should be treated with morphine

c. Nitroglycerin should be avoided if the client is experiencing this side effect

d. Acetaminophen or ibuprofen can be taken for this common side effect

d. Acetaminophen or ibuprofen can be taken for this common side effect

A hospitalized patient with a history of chronic stable angina tells the nurse that she is

having chest pain. The nurse bases his actions on the knowledge that ischemia

a. Indicates that irreversible myocardial damage is occurring

b. Will always progress to myocardial infarction

c. Is frequently associated with vomiting and extreme fatigue

d. Will be relieved by rest, nitroglycerin, or both

d. Will be relieved by rest, nitroglycerin, or both

Your chest pain patient shows an ST elevation in leads I, aVL, VS and V6. What type of

MI is the patient having?

a. Transmural MI

b. Septal

c. Inferior wall

d. Lateral wall

d. Lateral wall

Fatty streaks in the coronary arteries can, over time, develop into plaque and atherosclerosis. Which food is best to improve HDL cholesterol?

a. Coconut oil

b. Olive oil

c. Lard

d. Peanut oil

b. Olive oil

The nurse knows that when assessing a client suspected of having a myocardial infarction it is most important to ask to which of the following?

a. “What medications are you currently taking?”

b. “How long ago did the symptoms start?”

c. “Have you ever had similar symptoms in the past?”

d. “Have you had a lot of stress lately?”

b. “How long ago did the symptoms start?”

The nurse is caring for a client who recently experienced a myocardial infarction and has been started on clopidogrel (Plavix) 75mg daily. Which item below is not necessary to include when teaching about taking clopidogrel?

a. The client should take clopidogrel with food

b. The client may bruise more easily and ay experience bleeding gums

c. The client should report unexpected bleeding or bleeding that lasts a long time

d. Clopidogrel works by preventing platelets from sticking together and forming a clot

a. The client should take clopidogrel with food

Ms. R is a sixty year old who takes 81mg aspirin per day to protect against having an MI. She now presents to your ER with chest pain and is given 325mg of aspirin. What is the rationale for giving a higher dose of aspirin?

a. To prevent a possible thrombus in the coronary artery from growing larger

b. To prevent headache cause by nitroglycerin

c. To help dissolve the thrombus that has formed in the coronary artery

d. For its analgesic effect

a. To prevent a possible thrombus in the coronary artery from growing larger

Your patient is to receive a fibrinolytic to break-up a thrombus responsible for the STEMI he is experiencing. What finding would exclude the patient from being a candidate this therapy?

a. The patient has a history of synchronized cardioversion

b. The patient’s nephew is a hemophiliac

c. The patient had received the medication for a thrombolytic stroke five days prior

d. The patient has just been given nitroglycerin

c. The patient had received the medication for a thrombolytic stroke five days prior

The client who experiences angina has been told to follow a low-cholesterol diet. Which meal would be best?

a. baked liver, green beans and coffee

b. Hamburger, salad, and milkshake

c. Fried chicken, green beans, and skim milk

d. Spaghetti with tomato sauce, salad, and coffee

d. Spaghetti with tomato sauce, salad, and coffee

What is the rationale for putting a patient in acute decompensation heart failure in the High Fowler’s position with the legs flat on the mattress? (SATA)

a. This position facilitate rapid endotracheal intubation

b. It will make breathing easier

c. It will encourage blood flow to the heart

d. It will discourage blood return to the heart

b. It will make breathing easier

d. It will discourage blood return to the heart

13. Your patient’s echocardiogram report indicates that she ... ejection fraction of 21%. Which nursing diagnosis would ...

a. Decreased activity tolerance

b. Powerlessness

c. Knowledge deficit

d. Ineffective airway clearance

a. Decreased activity tolerance

A compensatory mechanism for heart failure that leads to inappropriate fluid retention and worsening workload of the heart

a. Ventricular hypertrophy

b. Ventricular dilation

c. Sympathetic nervous system activation

d. Neurohormonal response leading fluid retention

d. Neurohormonal response leading fluid retention

As a suicide attempt, M.H. took 30 tablets of 40mg furosemide (Lasix). The nurse should frequently assess for which findings?

a. Tachycardia, hypotension, slow cap refill and coarse crackles in the lungs as

evidence of worsening cardiogenic shock

b. Hyperkalemia

c. Urinary incontinence

d. Tachycardia, hypotension and slow capillary refill as a sign of hypovolemic shock

d. Tachycardia, hypotension and slow capillary refill as a sign of hypovolemic shock

The nursing diagnosis that best applies to your patient with compensated heart failure is:

a. Altered nutrition

b. Imparted gas exchange

c. Decreased compliance to therapy

d. Potential for activity into intolerance

d. Potential for activity into intolerance

Which two are indications that a client with a history of left-sided heart failure has developed pulmonary edema?

a. Tachycardia

b. Anorexia

c. Dependent edema

d. Distended jugular veins

e. Coarse crackles upon auscultation

a. Tachycardia

e. Coarse crackles upon auscultation

A patient with chronic heart failure and atrial fibrillation is treated with a digitalis glycoside (Digoxin) and a loop diuretic. To prevent possible complications of this combination of drugs, which three should the nurse do to assure safe administration? (SATA)

a. Teach the patient how to take a pulse rate

b. Monitor serum potassium levels

c. Teach the patient about dietary restriction of potassium

d. Keep an accurate measure of intake and output

a. Teach the patient how to take a pulse rate

b. Monitor serum potassium levels

d. Keep an accurate measure of intake and output

Immediately after cardioverting your patient, he goes into a normal sinus rhythm. What would be your next action?

a. Activate the rapid response team

b. Perform CPR for three minutes and shock again

c. Check the pulse

d. Assess for consciousness

c. Check the pulse

An older adult with a history of heart failure is admitted to the emergency department with via paramedic ambulance with pulmonary edema in High Fowler’s position. His skin is cool, diaphoretic and the patient is gasping for air. What should the first intervention

be?

a. Invert a foley catheter

b. Apply high flow oxygen

c. Take a full set of vital signs

d. Prepare for intubation

b. Apply high flow oxygen

While assessing the patient admitted to the unit with heart failure, the nurse notes jugular venous distention (JVD) while sitting in Semi-Fowler’s position at about 45 degrees. What action should the nurse do next?

a. Document it in the patient’s record

b. Obtain vital signs, include oxygen saturation

c. Check for ankle edema and pulmonary edema

d. Have the patient perform the Valsalva maneuver

c. Check for ankle edema and pulmonary edema

The nurse is caring for a patient with aortic stenosis. Which assessment data obtained by the nurse would be most important to report to the health care provider?

a. A thrill is palpated at the second intercostal space, right sternal border

b. The patient complains of chest pressure when ambulating

c. The point of maximum impulse (PMI) is at the left midclavicular line

d. A loud systolic murmur is heard along the right sternal border

b. The patient complains of chest pressure when ambulating

While caring for a patient with aortic stenosis, the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow. An appropriate nursing intervention for this patient would be to

a. Teach the patient to use sublingual nitroglycerin for chest pain

b. Raise the head of the bed 60 degrees to decrease venous return

c. Promote rest to decrease myocardial oxygen demand

d. Teach the patient about the need for anticoagulant therapy

c. Promote rest to decrease myocardial oxygen demand

Which clinical finding would most likely indicate decreased cardiac output in a patient

with aortic valve regurgitation?

a. Early onset of dementia

b. A wide QRS on the EKG and cardiac monitor

c. Shortness of breath on minimal exertion and diastolic murmur

d. Femoral venous distention and new-onset atrial fibrillation

c. Shortness of breath on minimal exertion and diastolic murmur

The nurse is caring for a 64 yo patient admitted w mitral valve regurgitation. Which information obtained by the nurse when assessing the patient should be communicated to the HCP immediately?

a. The patient has diffuse bilateral crackles

b. The patient has a loud systolic murmur across the precordium

c. The patient has a palpable thrill felt over the left anterior chest

d. The patient has 4+ peripheral edema

a. The patient has diffuse bilateral crackles

The nurse is caring for a patient with chronic constrictive pericarditis. Which assessment finding reflects a more serious complication of this condition

a. Fatigue

b. Thickened pericardium on echocardiography

c. Peripheral edema

d. Jugular venous distention

d. Jugular venous distention

A client returns from a cardiac catheterization procedure with a bandage over the right groin. An unlicensed personnel assigned to the client reports that the client’s right foot is cool to the touch. The most important action the nurse should do is

a. Check the foot every 15 mins

b. Call the providers and report the findings

c. Compare it to the temp of the opposite foot and compare pedal pulses

d. Loosen the bandage

b. Call the providers and report the findings

A client has returned from the cardiac catheterization lab after a balloon valvuloplasty formitral stenosis. Which finding requires immediate nursing action

a. There is a low, grade 1 intensity mitral valve regurgitation murmur upon auscultation

b. SPO2 is 94% on o2 2L/min via nasal cannula

c. The client has become more somnolent

d. UO decreased from 60mL/hr to 40mL/hr

c. The client has become more somnolent

29. Priority nursing management for a patient with myocarditis includes interventions related to (SATA)

a. Providing quiet environment

b. Decreasing cardiac workload

c. Meticulous skincare

d. Antibiotic prophylaxis

b. Decreasing cardiac workload

Your patient has returned from the cardiac catheterization lab. Which post procedure assessment parameter will assure large amounts of blood loss do not go undetected afterward?

a. Assessment for equal pedal pulses

b. Determination of the resp rate

c. Frequent assessment of the arterial or venous access site

d. The ability to move all extremities

a. Assessment for equal pedal pulses

c. Frequent assessment of the arterial or venous access site

The patient has ST segment changes that suggest an acute inferior wall myocardial infarction. Which lead would be best for monitoring this patient

a. V6

b. V2

c. II

d. I

c. II

A patient’s heart monitor shows a pattern of undulations of varying contours andamplitude with no measurable ECG pattern. The patient is unconscious, apneic, and pulseless. Which action should the nurse take first

a. Immediately perform two mins of high quality cpr and then defibrillation

b. Prepare for endotracheal intubation

c. Ventilate with a bag valve mask device

d. Give epinephrine IV

a. Immediately perform two mins of high quality cpr and then defibrillation

The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which method will be best to use

a. Calculate the number of small squares between one QRS complex and the next

and divide into 1500

b. Count the number of large squares in the R-R interval and divide by 300

c. Print a 1-min electrocardiogram strip and count the number of QRS complexes

d. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10

d. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10

Which lab result for a patient with multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the HCP

a. Serum potassium of 2.9

b. Blood glucose of 243

c. Serum sodium of 134

d. Serum chloride of 92

a. Serum potassium of 2.9

i. Ventricular fibrillation

ii. Supraventricular tachycardia

iii. Bradycardia sinus rhythm

iv. Normal sinus rhythm

iii. Bradycardia sinus rhythm

The nurse has received change of shift report about the following patients on the PCU. Which patient should the nurse see first

a. A patient with second degree AV block type 1, rate 60, who is dizzy when ambulating

b. A patient whose implantable cardioverter-defibrillator fired twice today and has a

dose of amiodarone due

c. A patient who is in a sinus rhythm, rate 98 and regular, recovering rom an

elective cardioversion 2 hours ago

d. A patient with atrial fibrillation, rate 88 and irregular, who has a dose of warfarin due

b. A patient whose implantable cardioverter-defibrillator fired twice today and has a dose of amiodarone due

What is the ECG rhythm above

i. Supraventricular tachycardia

ii. Sinus tachycardia

iii. Ventricular tachycardia

iv. Normal sinus rhythm

i. Supraventricular tachycardia

To determine whether there is a delay in impulse conduction through the ventricles, the nurse will measure the duration of the patients

a. P wave

b. QRS complex

c. Q wave

d. PR interval

b. QRS complex

A patient who was admitted with a MI experiences a 45 second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 bpm. Which action should the nurse take next

a. Document the rhythm and continue to monitor the patient

b. Immediately notify the HCP

c. Perform synchronized cardioversion per agency dysrhythmia protocol

d. Prepare to give IV amiodarone per agency dysrhythmia protocol

d. Prepare to give IV amiodarone per agency dysrhythmia protocol

A 19 yo student comes to the student health center at the end of the sem complaining that “my heart is skipping beats.” an ECG shows occasional unofficial premature ventricular contractions. What action should the nurse take next

a. Start supplemental O2 at 2-3 L/min via nasal cannula

b. Ask the patient about current stress level and caffeine use

c. Have the patient taken to the nearest ED

d. Insert an IV for emergency use

b. Ask the patient about current stress level and caffeine use

A patient develops sinus bradycardia at a rate of 32 bpm, has a BP of 80/42 and is complaining of feeling faint. Which action should the nurse take next

a. Apply the transcutaneous pacemaker pads

b. Give the scheduled dose os diltiazem

c. Have the patient perform valsava maneuver

d. Recheck the heart rhythm and BP in 5 mins

a. Apply the transcutaneous pacemaker pads

A patient who is on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action is included in the hospital dysrhythmia protocol should the nurse do first

a. Obtain a 12 lead ECG

b. Give supplemental O2 at 2-3 L via nasal cannula

c. Notify the HCP of he change of rhythm

d. Assess the patient’s VS including O2 sat

a. Obtain a 12 lead ECG

b. Give supplemental O2 at 2-3 L via nasal cannula

Which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and has a BP of 110/60

a. Provide assisted ventilation w a bag valve mask divide

b. Give a sedative before cardioversion is implemented

c. Turn the synchronizer switch to off

d. Set the defibrillator energy to 360 joules

b. Give a sedative before cardioversion is implemented

When analyzing the rhythm of a pt ECG, the nurse will need to investigate further upon finding a

a. PR interval of 0.18 s

b. QT interval of 0.38 s

c. QRS interval of 0.14 s

d. Isoelectric ST segment

c. QRS interval of 0.14 s

Which action by a new RN who is orienting at the telemetry unit indicates a good understanding of the treatment of heart dysrhythmias

a. Turns the synchronizers switch to on

b. Prepared defibrillator settings at 360 joules for a patient whose monitor shows asystole

c. Injects IV adenosine

d. Gives the prescribed dose of ...

c. Injects IV adenosine

A 20 yo patient has a mandatory ECG before playing soccer. Found sinus bradycardia, rate 52. BP 114/54 and the student denies health problems. Which action by the nruse is most appropriate

a. Tell the student to stop playing if dyspnea occurs

b. Obtain more details about student health history

c. Refer the student to a cardiologist for further teaching

d. Allow the student to participate on the soccer team

d. Allow the student to participate on the soccer team

A client with a known history of heart failure (aka congestive heart failure) states she has gained 7 pounds this week. In assessing the situation, it would be most important for the nurse to

1. Examine the client’s legs and sacral area

2. Immediately administer furosemide (Lasix).

3. Auscultate the lungs for a pericardial friction rub.

4. Weigh the patient and compare it with the patient's baseline.

4. Weigh the patient and compare it with the patient's baseline.